Lesson 3: There are other things in the Allergist's life besides asthma. Open up your vistas, and start thinking of ALL mucosal organs (and the skin) as targets for allergic disease. Our professional societies have done a good job at ‘marking our territory’ as asthma–that's all well and good, but you'll see plenty of patients with urticaria, migraine headaches, fatigue, and other issues besides asthma. Many of these patients come with a mix of IgE and non-IgE mediated illness. In truth, the allergist who only treats asthma is like the musician who only plays one song–it gets pretty boring and it is an incredible waste of talent.

_Lesson 4: Revel in the mystery of allergy and develop your sense of curiosity in your practice. Just because we can't explain a patient's reaction in terms of what we presently understand from our training program, there is no need to deny it exists or delight in the mystery of how it happens. Why does Mrs. Smith get tired shortly after eating wheat products? Why does Mr. Smith get a headache 12 hours after cleaning up a moldy basement? Why do Mr. and Mrs. Smith have negative prick tests and IgE negative RAST tests to wheat and mold?

_There is a subliminal tendency in many young allergists to not be interested in anything they can't explain. An observation is denied because the pathophysiology is unclear. That's backwards. It is the patient reactions we can't explain that should interest us the most! Thinking should begin with the negative prick test and the negative RAST test…not the positive ones. There are many, many, things we do not understand about how food and aeroallergens affect the patient, and the sooner we humbly acknowledge this, the better. This is the ‘Grand Mystery’ of allergy. Accept it, embrace it, and study it.

_Keep these four lessons in mind as you start your practice and you'll have a satisfying and rewarding practice for many years to come.

_AchooAllergy.com would like to thank the writer for their permission to reprint this letter to a young allergist.